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Impact of complex chronic diseases and life-limiting condition status on paediatric hospitalization: observational
Idoya Serrano-Pejenaute1,2, Itziar Astigarraga3,4, Álvaro Sánchez Pérez5
1Department of Pediatrics, Hospital of Zumarraga, Barrio Argixao, S/N, 20700, Zumarraga, Spain. idoya.serranopejenaute@osakidetza.eus.
Insights
Children with complex chronic diseases (C-CD) and life-limiting conditions (LLC) significantly increase hospitalizations and mortality. Life-limiting conditions showed a higher impact on resource utilization and death probability in pediatric patients.
Area of Science:
- Pediatric healthcare utilization
- Public health systems
- Complex chronic diseases
Background:
- Children with medical complexity (CMC) utilize significant healthcare resources and have high in-hospital mortality.
- Both complex chronic diseases (C-CD) and life-limiting conditions (LLC) are categories of CMC.
- There is overlap between C-CD and LLC, with both groups showing high resource use and mortality, particularly LLC.
Purpose of the Study:
- To assess the impact of CMC and LLC on hospitalizations within the Basque Public Health System (BPHS).
- To compare inpatient health utilization between children with C-CD and LLC.
- To characterize the differences in healthcare resource consumption and mortality between these pediatric groups.
Main Methods:
- Retrospective observational study of pediatric admissions (0-18 years) in the BPHS from 2018-2020.
- Identification of C-CD using the Pediatric Medical Complexity Algorithm.
- Identification of LLC using the Hain Directory of Life-Limiting Conditions.
Main Results:
- C-CD and LLC accounted for 15.4% and 14.4% of total pediatric admissions, respectively.
- Patients with LLC were more likely to require respiratory/hemodynamic support and device placement than C-CD patients.
- Children with C-CD and LLC had higher admission frequency, longer stays (general and ICU), and increased in-hospital mortality, especially those with LLC.
Conclusions:
- A substantial proportion of pediatric hospital admissions are due to C-CD and LLC.
- Both conditions lead to significant hospital resource utilization and high in-hospital mortality, with LLC being more pronounced.
- Further research on cost and expenditures is recommended for publicly funded health systems.
Abstract:
Children with medical complexity (CMC) and life-limiting conditions (LLCs) have a high utilization of healthcare resources. This study aims to assess the impact of CMC and LLC on hospitalization in the Basque Public Health System (BPHS) and to compare CMC to LLC to characterize inpatient health utilization. This is a retrospective observational study including all admissions of paediatric patients (< 19 years) to the BPHS during the period 2018-2020. The Pediatric Medical Complexity Algorithm and the Hain Directory of Life-Limiting Conditions were used to identify children with complex chronic diseases (C-CDs) and LLCs, respectively. Inpatient health utilization and in-hospital mortality of patients with C-CD and LLC were compared to those without these conditions. A total of 34,555 admissions were recorded for 26,196 patients during the study period. Patients with C-CD and LLC accounted for 15.4% and 14.4% of these admissions, respectively. Patients with LLC were more likely to require respiratory or hemodynamic support and device placement than patients with C-CD. Children with LLC and C-CD exhibited a higher frequency and length of stay of both general and ICU admissions than those without these conditions. Eight out of ten patients who died during admission had C-CD and/or LLC, with a higher probability of in-hospital death among patients with LLC.
Conclusion:
A considerable proportion of admissions among children was attributed to patients with C-CD and LLC. Both exhibited substantial utilization of hospital resources and high in-hospital mortality, being more pronounced among patients with LLC. Further studies focused on cost/expenditures are needed within a publicly insured health system.
What Is Known:
• Children with medical complexity (CMC) consume a lot of healthcare resources, and their in-hospital mortality is high. There are several ways to identify CMC in health datasets. Both children with chronic complex disease (C-CD) and life-limiting conditions (LLC) are CMC.
What Is New:
• There is an important overlap between children classified as having C-CD and those with LLC. Both groups exhibited substantial utilization of hospital resources and high in-hospital mortality, being more pronounced among patients with LLC.
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